Department of Veterans Affairs VHA Directive 1131(5) Veterans Health Administration Transmittal Sheet Washington, DC 20420 November 7, 2017 MANAGEMENT OF INFECTIOUS DISEASES AND INFECTION PREVENTION AND CONTROL PROGRAMS 1. REASON FOR ISSUE: This directive establishes requirements in Department of Veterans Affairs (VA) medical facilities for Infectious Diseases and Infection Prevention and Control Programs. NOTE: Requirements and responsibilities regarding HIV and viral hepatitis are under the National HIV Program and the National Viral Hepatitis Program in the HIV, Hepatitis, and Related Conditions Program within the Office of Specialty Care Services (10P11) and are beyond the scope of this document and the purview of NIDS. For more information about these programs visit the VHA Web sites on HIV, https://www.hiv.va.gov/ and viral hepatitis https://www.hepatitis.va.gov/. 2. SUMMARY OF CONTENT: a. Amendment dated June 4, 2021, adds Appendix J that provides revised guidelines for the Prevention of Clostridioides difficile Infection in VA inpatient facilities. b. Amendment dated April 01, 2021 adds Appendix I, regarding standard terms for use in electronic health records and related room signage and adds definitions to paragraph 3. VA medical facilities must implement standard naming conventions set forth in Appendix I within 120 days of amendment publication. c. Amendment dated November 22, 2019 adds Appendix H. d. Amendment dated July 16, 2019 adds Appendix G. e. Amendment dated December 4, 2018 includes the addition of Appendix F, Prevention of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in VHA Inpatient Acute Care Facilities. The addition of Appendix F subsequently rescinds VHA Directive 2006-006, Methicillin-Resistant Staphylococcus aureus (MRSA) Prevention Initiative. f. This new Veterans Health Administration (VHA) directive consolidates and rescinds two directives and one manual chapter addressing infectious diseases and infection prevention and control related topics. (1) Definition for contact precautions. (2) References for Methicillin-Resistant Staphylococcus aureus (MRSA)-specific documents and guidance. (3) Appendix F, Prevention of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in VHA Inpatient Acute Care Facilities. T-1 November 7, 2017 VHA DIRECTIVE 1131(5) 3. RELATED ISSUES: VHA Directive 1031, Antimicrobial Stewardship Programs; VHA Handbook 1101.10, Patient Aligned Care Team (PACT) Handbook; VHA Directive 1304, National Human Immunodeficiency Virus (HIV) Program; and VHA Directive 1300.01, National Viral Hepatitis Program. 4. RESPONSIBLE OFFICE: The National Infectious Diseases Service (NIDS, 10P11), within Specialty Care Services, Office of the Deputy Under Secretary for Health for Policy and Services (10P), is responsible for the contents of this VHA directive. Questions may be referred to the Director, National Infectious Diseases Service at 513- 246-0270. 5. RESCISSIONS: VHA Directive 2011-007, Required Hand Hygiene Practices, dated February 16, 2011; VHA Directive 2013-008, Infectious Diseases Reporting, dated June 25, 2013; and Manual M-2, Clinical Programs, Part IV, Medical Service, Chapter 6, Infectious Diseases, dated April 29, 1994; are rescinded. 6. RECERTIFICATION: This VHA directive is scheduled for recertification on or before the last working day of November 2022. This VHA directive will continue to serve as national VHA policy until it is recertified or rescinded. Carolyn M. Clancy, M.D. Executive in Charge DISTRIBUTION: Emailed to the VHA Publications Distribution List on November 27, 2017. T-2 November 7, 2017 VHA DIRECTIVE 1131(5) CONTENTS MANAGEMENT OF INFECTIOUS DISEASES AND INFECTION PREVENTION AND CONTROL PROGRAMS 1. PURPOSE ................................................................................................................ 1 2. BACKGROUND ........................................................................................................ 1 3. DEFINITIONS ........................................................................................................... 2 4. POLICY .................................................................................................................... 6 5. RESPONSIBILITIES ................................................................................................. 6 6. REFERENCES ....................................................................................................... 10 APPENDIX A BACKGROUND OF THE NATIONAL INFECTIOUS DISEASES SERVICE ................A-1 APPENDIX B INFECTIOUS DISEASES AND INFECTION PREVENTION AND CONTROL PROGRAMS AT VA MEDICAL FACILITIES ................................................................B-1 APPENDIX C MULTI-DRUG RESISTANT ORGANISM (MDRO) PREVENTION INITIATIVE PROCEDURAL GUIDANCE ....................................................................................... C-1 APPENDIX D VETERANS HEALTH ADMINISTRATION MULTI-DRUG RESISTANT ORGANISM (MDRO) PREVENTION INITIATIVE TASK FORCE .................................................... D-1 APPENDIX E INFECTIOUS DISEASE REPORTING .........................................................................E-1 APPENDIX F PREVENTION OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) INFECTIONS IN VHA INPATIENT ACUTE CARE FACILITIES ................................... F-1 APPENDIX G PREVENTION OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) INFECTIONS IN VHA COMMUNITY LIVING CENTERS ............................................ G-1 i November 7, 2017 VHA DIRECTIVE 1131(5) APPENDIX H PREVENTION OF INFECTIONS DUE TO CARBAPENEMASE-PRODUCING GRAM- NEGATIVE ORGANISMS IN VHA FACILITIES .......................................................... H-1 APPENDIX I STANDARD TERMS FOR SPECIAL AND TRANSMISSION-BASED PRECAUTIONS CATEGORIES ............................................................................................................... I-1 APPENDIX J REVISED GUIDELINES FOR THE PREVENTION OF CLOSTRIDIOIDES DIFFICILE INFECTION IN VA INPATIENT FACILITIES ................................................................ J-1 ii November 7, 2017 VHA DIRECTIVE 1131(5) MANAGEMENT OF INFECTIOUS DISEASES AND INFECTION PREVENTION AND CONTROL PROGRAMS 1. PURPOSE This Veterans Health Administration (VHA) directive provides policy and establishes requirements for the management of Infectious Diseases and Infection Prevention and Control Programs within the Department of Veterans Affairs (VA). This directive defines the minimum Infectious Diseases and Infection Prevention and Control Programs and services that must be made available at all VA medical facilities. NOTE: Based on Program alignment in VHA, requirements regarding HIV and viral hepatitis are beyond the scope of this document and the purview of NIDS, and are under the National HIV Program and the National Viral Hepatitis Program in the HIV, Hepatitis, and Related Conditions Program within the Office of Specialty Care Services. AUTHORITY: Title 38 United States Code (U.S.C.) 7301(b). 2. BACKGROUND a. Management of infections and control and prevention of infectious diseases in VHA follow evidence-based practices across VA medical facilities. While some basic national guidance and framework is provided, many aspects of Infectious Diseases and Infection Prevention and Control Programs are locally administered and applied, based on local context, needs, and assessments of risk. b. The National Infectious Diseases Service (NIDS) is comprised of several different programs (Clinical Management Services, Infection Prevention and Control Program, and Infectious Diseases Biosurveillance) and provides primary subject matter expertise in VA and VHA for infectious diseases, antimicrobial stewardship, infection prevention and control, and infectious diseases biosurveillance activities. NIDS is a consultant and subject matter expert to VA and VHA Central Office, Veterans Integrated Service Networks (VISNs), and VA medical facilities, and provides current and evidence-based guidance related to infectious diseases and infection prevention and control in order to provide the highest quality of care to Veterans. Information about NIDS policy and guidance can be found at the NIDS Web site, http://vaww.va.gov/INFECTIOUSDISEASES/. NOTE: This is an internal VA Web site that is not available to the public. Background on NIDS can be found in Appendix A. NIDS has been charged to: (1) Provide a VHA Central Office service for consultation and technical assistance with respect to infectious diseases and infection prevention and control. (2) Develop policy and guidance for emerging changes in the field of infectious diseases and infection prevention and control, which includes, but is not limited to, antimicrobial stewardship, infectious diseases biosurveillance, and prevention programs. c. The provision of infectious diseases clinical services and infection prevention and control within VHA follows, at a minimum, the core guidance and recommendations 1 November 7, 2017 VHA DIRECTIVE 1131(5) developed by NIDS. NOTE: Based on Program alignment in VHA, requirements regarding HIV and viral hepatitis are beyond the scope of this document and the purview of NIDS. See VHA Handbook 1101.01, Patient Aligned Care Team (PACT) Handbook for additional policy related to infectious diseases PACT. Recognizing that each VA medical facility is unique with local programs that may vary from other facilities, as part of a national system, it is the expectation that each facility must provide consistent high-quality